Sr Credentialing Rep

Responsibilities

• Prepare and submit initial credentialing and recredentialing applications for providers with contracted insurance payers, ensuring all records are complete and timely.
• Maintain provider licenses, certifications, and related documents by monitoring expiration dates and coordinating renewal activities.
• Update and manage CAQH profiles and other enrollment records to keep practitioner information accurate across credentialing platforms.
• Perform roster maintenance, delegation-related data entry, and payer record updates within systems such as Symplr Payer and other credentialing tools.
• Conduct primary source verification by reviewing licensing boards, certification databases, and other approved sources to confirm provider qualifications.
• Process enrollments with commercial insurers and government programs, including plans governed by applicable state and federal requirements.
• Review credentialing files for quality, completeness, and alignment with NCQA, AAAHC, Joint Commission, and internal compliance standards.
• Support hospital privilege documentation and verify related information to help maintain accurate provider participation records.

Requirements

• Previous experience in provider credentialing, payer enrollment, or healthcare data administration.
• Working knowledge of credentialing standards and regulatory requirements, including CA rules, Medi-Cal, NCQA, AAAHC, and Joint Commission expectations.
• Hands-on experience with systems such as Symplr Payer, Cactus, PECOS, MD Staff, or similar credentialing and enrollment platforms.
• Proficiency in Microsoft Excel, Word, PowerPoint, and Smartsheet for tracking, reporting, and documentation management.
• Strong understanding of CAQH maintenance, primary source verification, and provider file auditing processes.
• Able to manage detailed data entry tasks with a high degree of accuracy and organization.
• Familiarity with hospital privileging processes and enrollment procedures for both commercial and government payers.

Qualifications

The ideal candidate will have:

• A bachelor's degree in healthcare administration, business, or a related field.
• At least 3 years of relevant experience in provider credentialing, payer enrollment, or healthcare data administration.
• Knowledge of healthcare regulations and standards, including CA rules, Medi-Cal, NCQA, AAAHC, and Joint Commission expectations.
• Experience with healthcare information technology systems and software, including Symplr Payer, Cactus, PECOS, MD Staff, or similar platforms.
• Excellent organizational and communication skills, with the ability to manage multiple tasks simultaneously.
• Ability to work independently and as part of a team, with strong attention to detail and accuracy.

Skills

• Strong attention to detail.
• Knowledge of credentialing standards and regulatory requirements.
• Hands-on experience with healthcare information technology systems.
• Proficiency in Microsoft Office Suite.
• Experience with CAQH maintenance, primary source verification, and provider file auditing processes.
• Understanding of hospital privileging processes and enrollment procedures.

Benefits

Robert Half offers competitive compensation and benefits, including medical, vision, dental, and life and disability insurance. Contract/temporary professionals are also eligible to enroll in our company 401(k) plan. For more information, visit roberthalf.gobenefits.net.

Pay

Compensation is commensurate with experience.

Schedule

Full-time position.